Mares D C, Mathur P N
Department of Medicine, Indiana University Medical Center, Indianapolis 46202-2879, USA.
Chest. 1998 Sep;114(3):731-5. doi: 10.1378/chest.114.3.731.
Recurrent chylothorax as a complication of lymphoma has had unsatisfactory outcomes. Serial thoracentesis, tube thoracostomy, and pleurodesis via chest tube have been ineffective and compromise the nutritional and immune status of the patient. Medical thoracoscopic talc pleurodesis has been safe and effective in the treatment of some other varieties of recurrent pleural effusions. Our objective was to investigate the safety and efficacy of medical thoracoscopic talc pleurodesis in the palliation of chylothorax related to lymphoma.
This is a report of 24 hemithoraces treated in 19 consecutive patients with lymphoma-related chylothorax, failing chemotherapy or radiation therapy. The average patient age was 55 years.
Medical thoracoscopy was performed under local anesthesia and conscious sedation in a bronchoscopy suite. Sedation included midazolam (mean dose, 6 mg; range, 2-14 mg) with either meperidine (mean dose, 94 mg; range 25-140 mg), or morphine (mean dose, 18 mg; range 4-40 mg). Pleurodesis was performed with insufflation of sterile asbestos-free talc, (4-8 g). After pleurodesis, chest tubes were placed, with the mean duration of chest tube placement being 4 days, range 3 to 10 days.
One patient died a few days after the procedure due to causes related to the primary disease process. Follow-up was for at least 90 days following the procedure. Patients were assessed at 30, 60, and 90 days following the procedure. At each of these endpoints, all patients remaining alive were without recurrence of pleural effusions, which was confirmed by chest radiography. Eight patients in the series died of the effects of their malignancy during the 90-day evaluation interval. Complications included medication reactions in two patients (8.3%) and ARDS in one patient (4.1%).
Many patients with lymphoma-related chylothorax are refractory to chemotherapy and/or radiation therapy. In this group, medical thoracoscopic talc pleurodesis has an acceptable complication rate and a 100% success rate in the prevention of recurrence of pleural effusions at 30, 60, and 90 days following the procedure.
乳糜胸作为淋巴瘤的一种并发症，其治疗效果并不理想。胸腔穿刺术、胸腔闭式引流术以及经胸管胸膜固定术均效果不佳，且会损害患者的营养和免疫状态。内科胸腔镜滑石粉胸膜固定术在治疗其他类型的复发性胸腔积液方面已被证明是安全有效的。我们的目的是研究内科胸腔镜滑石粉胸膜固定术缓解淋巴瘤相关乳糜胸的安全性和有效性。
这是一份关于19例淋巴瘤相关乳糜胸患者的24侧胸腔治疗报告，这些患者化疗或放疗失败。患者平均年龄为55岁。
在内科支气管镜检查室，于局部麻醉和清醒镇静下进行内科胸腔镜检查。镇静药物包括咪达唑仑（平均剂量6mg；范围2 - 14mg），联合哌替啶（平均剂量94mg；范围25 - 140mg）或吗啡（平均剂量18mg；范围4 - 40mg）。通过注入无菌无石棉滑石粉（4 - 8g）进行胸膜固定术。胸膜固定术后放置胸管，胸管放置的平均时长为4天，范围3至10天。
1例患者在术后数天因原发性疾病相关原因死亡。术后随访至少90天。在术后30、60和90天对患者进行评估。在每个评估时间点，所有存活患者均无胸腔积液复发，胸部X线检查证实了这一点。在90天评估期内，该系列中有8例患者死于恶性肿瘤。并发症包括2例患者（8.3%）出现药物反应，1例患者（4.1%）发生急性呼吸窘迫综合征（ARDS）。
许多淋巴瘤相关乳糜胸患者对化疗和/或放疗无效。在这组患者中，内科胸腔镜滑石粉胸膜固定术的并发症发生率可接受，且在术后30、60和90天预防胸腔积液复发的成功率为100%。
